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018-1092-06-000
ST. CR O C► '` [ ^iTY. Land Use Planning&Land Information GSZ�4'f f'Z' Resource Management Community Development Department September 9,2014 Anthony Mueller&Jennifer Grabczyk 1187 207 'Street Baldwin,WI 54002 Determination for Land Use Permit-Parcel#01.29.17.738,Town of Hammond Site Address: Lot 6 Pine Lake Subdivision CDD staff met on September 5th to review your plans for constructing an accessory structure on the above site as shown on your concept site plan. The proposed construction site is located south of the existing house and will meet required structural setbacks from the property line and Pine Lake's Ordinary High Water Mark(OHWM). It will also be outside/above the floodplain elevation for the lake. This letter is a determination regarding zoning permits that may/may not be necessary for your proposed project(s)in the Shoreland overlay district. The proposed accessory structure will be 34' x 36'or 1,224 sq.ft. in size. Applicable Shoreland ordinances are summarized below: Code Proposed Project Standards&Requirements References 17.30 F.4 The proposed pole building will be a legal conforming accessory structure that will be>75' &G.1 &G.2 from the OHWM of Pine Lake. The proposed accessory structure must meet all other required structural setbacks and height limitations for an Ag-Residential property per General Zoning ordinances. 17.30.I.2.a.1) There will be a net land disturbance(grading)of less than 2000 sq. ft.on slopes<12%within 300' of the lake's OHWM for this project;this amount of land disturbance is exempt from a land use permit. 17.30.J.I -4 The calculated impervious surface areas on this site after construction will be 3000 sq. ft. or 6.9%of the total land within 300' of the OHWM. This is below the 10%total impervious surface allowed without mitigation. Storm water runoff from the new building's roof should, however,be directed into areas that allow infiltration into the soil and not create a direct discharge into the lake. A stormwater management plan is not required at this time. 17.30 L.1 There is existing vegetative buffer within a 35' shoreline buffer zone from the OHWM and no ro osal to remove vegetation within 75' of the OHWM. At this time,your proposed construction will not require any land use permits. If your plans change and you wish to install any plumbing in the accessory structure that will connect to a Private On-site Wastewater Treatment System,a sanitary permit would be required. Please feel free to call or email if you have any questions regarding this Shoreland zoning permit determination. c. Palm Quinn, C D Land Use Specialist pam quinnga co.saint-croix.wi.us Cc: Todd Dolan, Hammond Building Inspector Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, W154016 Fax 715.386.4686 www.sccwi.us/cdd www.facebook.com/stcroixcountywi cdd @co.saint-croix.wi.us Design #: 63220 'f 8/1912014 Items Selected; Options Selected: Front view Standard Building Type The options you have chosen are: 9'Truss Spacing,Estimated With 4112 Pitch Service hors Truss Design Location Zip Code:54002 Service Windows law Flooring Type:Concrete . -3.48"x36"White Aluminum SP w/Screen J-Trim Post Frame Dimensi $�34'x35x9'6" (1)OH Doogs)16'X7'Insulated Ribbed White Sidewall. Endwall: 2X8 CCA Grade Board (1)Overhead Door Openers) NO Doors -8'z9'6"Single Slider 264 DP The Steel Panels You Have Chosen Are: (1)8'x9'6"Single Step Frame Brite Red Slider(s) Walls==>Brite Red Premium Pro-Rib -Roof==>Brite Red Premium Pro-Rib Trim=_>White Brite Red Ridgecap Back View Galvanized Neoprene Washer Screws for the Roof Air Galvanized Neoprene Washer Screws for the Walls Roof Fasteners On Rib;Wall Fasteners On Rib Bottom Trim 12"Front Sidewall Overhang Sidewall: Endwall: 12"Back Sidewall Overhang •No Doors -16xT Overhead 108'DF 12"Front EmWIl Overhang 12"Back Endwall Overhang White Soffit Color 4"Fascia Trim Inside Closure Strips �� �- Custom Mini-Print To Aid In Construction •5 IL l-.0- t3Q-1 Estimated base price: $6,962.76* Estimated Price: $9,276.23* Base Price inches galvanized nails,ddgeap,roof and side steel,white rake and comer trim, "Today's estimated price,future pricing may go up or down. doors as selected on the main buildmg.Base does not include lean-to materials 4 selected. Tax,labor,and delivery not included. ***Take this sheet to the Building Materials counter to purchase your materials. Floor type(conaete,dirt,gravel)is NOT included in estimated price.The floor type is used in the calcuiation or materials needed labor ra tfatrrd pin,sNel beams paid.eM dotal,heating pwmDmg.and delirefy see also NOT included ir.estimated pone This is estimate It is orgy for general price information.This is not an offer and there can be no legally binding contract between the parties based on this elate The pices stated heron are Subled to change doWding upon the market conditions.The prices slated on INS esfniate are not tirrn for any time period unless SWiiCaq written othenwise on this form.The avaMilily of maleriats is subjeCt to memory conditions.MENARDS IS NOT RESPONSIBLE FOR ANY LOSS INCURRED BY THE GUEST WHO RELIES ON PRICES SET FORTH HEREIN OR ON THE AUAt1ABIUTY OF ANY MATERIALS STATED HEREIN All information on this form,other than pace,has been provided by the guest and Men"is not resporwbie for any errors m the nIDON50n on this e0mak including but not Mod to quamiry,dmenum and qualty Please exams a Ws estimate careh*MENARDS MAKES NO REPRESENTATIONS.ORAL,WRIFTEN OR OTHERWISE THAT THE MATERIALS LISTED ARE SUITABLE FOR ANY PURPOSE BEING CONSIDERED BY THE GUEST BECAUSE OF THE WIDE VARIATIONS IN CODES.THERE ARE NO REPRESENTATIONS THAT THE MATERIALS U! HEREIN MEET YOUR CODE REOUIREMENTS.THE PLANS ANDIOR DESIGNS PROVIDED ARE NOT ENGINEERED LOCAL CODE OR ZONING REGULATIONS MAY REWIRE SUCH STRUCTURES TO BE PROFESSIONALLY ENGINEERED AND CERTIFIED PRIOR TO CONSTRUCTION Mo ll--Croix Building Permits Site Plan Form (See reverse for check list and sample) 1810 Crest View Drive,suite#1C Hudson,Wl 54016 715-377-2152 e � r � r e ° � n Name and Property Address. °�'t r.vt I)E_\.re_A1.f wRI ;4O= ��l�i��o� ,�.•� !car*that the above Site Plan is a true entation of this lot and accurately shows alf dimensions,easements,and proposed and existing structures on sold lot nY deviation from this approved Site Plan may void the Permit Signature of Owner/Builder or Contractor. Date: Page 6 ' of i n! as v so•& I n v n I •- '3Sf10H JNLLSIX3 a 07 I H1NA L 101 Ol MAOM 38 C 1313NIVaa ONLLSIX3 :MON UN Zb'£Z L l I NOLLVAM3 O IN'M-H'O ca 05tL 4 � 38 / v 0 ' / 1 5Z a ar/ s�brJ1r ALi•i Y� 3IN 1 /W 9 ow z W ( << ; s Q' 00 / 4I8NOOSIM `AJLNt100 xiomo '18. `QNt7 VVW L N011038 NI 'I'1d tb/ L3N J0 13AOD clO .L�11o%1 i Z 101 +1Ng, W N H 3 J � d d. x •�Ct cr- n I{1 _f a zf 4 r cl ti m V? w y 1 J 1 J y, V VascoNM 5n M- AT WARRAMT DUD -D.Secrewry d2w mg and UrbanDwelopowt dWO&wO n,D_C,QW=t abd"Grjof)-Hereby conveys ud*WWIYIV= 10 a wG=g* s)j fw MAn( 4 b� jl Goa afWG.S=Vl JAM.\ iLA.RV (S'10A0)and adwso Pwv dmft co�idecadws tha r ecdot o�f%wa is hereby aclmowlM%4 tofol�awio�tract of I=d k St-C mIC of Wsu�O: Britt ft same prop fired by lie S=1=7 omuft nd Uzbw Developb wt of W'asbkctoo,D-C PS c adonW A as amended 12 U.S.C1701 )and ffie Depart of 8oasiag and m the provisions of N Hoasm� sd► ( �tQ- Urban Developmatt d(4 U.8-CMI d-gq-3 MS D®7S NO TO BE IN Ei+' =VATU-- JJuty=2Q14 THM DEED IS FROM TAMSM FEE AkM FORM PER SEMON 77.25(2)WIS.STATS TO ELkvBjt ND TO HOLD Se said premises as am aesm'bed.wft to bad acAappaftamaaes =to tyre said k and to boss' a f bee)Ytaa and ads Ucv= SUBJECT 7 0 ALL covecnds,xOtsct M&aw=M=ndffi=zod,x%hMS appeafg of record:and SUBJECT to aoay staoe Offaet3 a acwraft stiaveywCUldshaw . AND TEE tat WshewHLdcftdthstideaadpossaskaof*a C,rmtx(s),Wvbe:(tb ' bets awd a mSm apin.t all iawtnl g bK diaongh,w tmderIse said Gamtor,and R�EOF,to on �0 30L,bas seiTris/harhmd and sal asa =xVera�oecafM&MartmRedEstate mdMadaetmgco a-of the V.S.Depa bneunt sadUrbrmDevdop�f,�uamid as $c ofHoosia�andIIrbaa Devdapmm%under I te redekg6on of aulo&y pubMad at Med.Reg.3723Z.Page 37256(Jamie 20,20 32)- seaman' ant.LLC As Prime bad 0 6112 A,-1 Y ' (Print orTypcNama) OtintorType TStle) Como►a f� ) ,mega- w= dVdbd=meth;s dwof 2oi�,t� wn Solis sari Deleaa�oa of - ao bebdf ac � win and Vrbm De+dagooat NotatyPUbiic Any Co=MM ��( Pp-91� PrnperryAddrrss: �--' = = No Cf N u rja Corrtm;s S,On S to°�`texas rm.a+ JQr1 Or3'20, 201$res St. Croix County 9 9206 Page 2 of 3 999206 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI Warranty Deed RECEIVED FOR RECORD Document Number Document Title 07/28/2014 09:20.AM EXEMPT # 2 REC FEE: 30.00 PAGES: 3 j **The above recording information verifies that this document has been electronically recorded &returned to the submitter Recordin Area Name and Return Address Bumet Title 5151 Edina Industrial Blvd.#500 Edina,MN 55439 14-08944 018-1092-06-000 Parcel Identification Number(PIN) I j i St Croix County 999206 Page 1 of 3 i Lot 6 of the Plat of P ne Lake recorded at the Office of the St Croix County Register of Deeds on INarch 19, 002 in Volume 8 of Phats,on Page 98 as Document No.673841, located in part of Go rernment Lot 2,part of Government Lot 3 and part of the Southwest Quarter(SW'/.)of tt a Northeast Quarter(NE Y.),All in Section 1,T29N,R17E,Town of Hammond,St Clout Dounty,Wisconsin I i i I i i St. Croix County 999206 Page 3 of 3 i oNO 4 0 up caa)i N W ° ` g o o w-p I a U) as � U � u� ° a O r C T C Q J O 4 w N C C ° 0.2) L N N N 10--O a> c 00 O L w c Z me m c to LL O 'y CL v o Q U tC w M O- W £ M Z o 3 CL co m w� E °, CO Q N oiS N p n T O O Z —e N p N N�c m Z :!! ! N c u >N p fA H N E N O N O _N N N w O N L C M Q. •N -° L 7")"O N OQ Q acid 7 N � zz E c 0 w, 12 .. 'M m 1� ° - J N d N y w fn U) N E • it " IL CL CL IL ° ugi 3 0 0 a� 0 `` p } 01 N_ m N Z N O O C, N N O O •= C) •g � O_ IM r C 0 '6 N n (!1 0 Y Q O O O c N y C rr O r c O O p a0 O n N to co U O M N .. N C C C LL N N N O O C ° C j t6 C O tp 4r O O U C, C } N = 64 u N E v d ° a S d °' 'Aj o 0 2 Q v o Z y a V a L `1�i �Cd+ E 2 'E c «t Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. C roix Safety and Building Division INSPECTION RtPORT Sanitary Permit No: 453470 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Alm, Scott I Hammond Townsh 018 - 1092 -06 -000 CST BM Elev: Insp. BM Elev: BM Description: nn Sectionrrown /Range /Map No: IJ L - 's 7 01.29.17.738 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer W.9 SG,.zz� Holding St/Ht Inlet SUHt Outlet TA # SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom ;r Dosing 7 , N oz , _ Header /Man. 3, Z3 57.89 Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover �u t� I c ✓ GPM Model Number ja 7j 153 C tid-- u � to •`t 95 -S � TDH Lift Friction Loss System Head TDH Ft '3 .. A,t Forcemain Length Dia. Dist. to well /v I L SOIL ABSORPTION SYSTEM &T Sa.0 jQ� BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Insi a D' epth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL ILAKEISTREAM LEA G Ma cturer: INFORMATION Type Of System: CH BER OR "� �� NO r , UNIT Model Number: ("f L•- I �J DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size `, x Hole Sp a Vent to Air Intake i � Pipe(s) I �� ,t I / II (;A0 ,, Length Dia Length 134 Dia `( Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched BedITTench Center Bed/Trench Edges Topsoil ,p C� [5] Yes A No 0 Yes � No COMMENTS: (Include c ode dis rc epe cie persons present, etc.) Inspection #1: 1 / ( Z � `✓� / 0` Inspection #2: c ! Location: 1187 207th Street Baldwin, WI 54002 (SW 1/4 NE 1/4 1 T29N R17W) Pine Lake Lot 6 r ParcJNN 01.29.17.738 1.) Alt BM Description = 5 v,3 F--A-'r ry y� 2.) Bldg sewer length = a y - amount of cover = > Required? l Yes I Plan revision Re `? 4 _ 4 L`_ a Use other side for additional inform on. 1 .. / L - - — - - - - -J -- SBD - 6710 (R.3/97) Date Insepctor's Signature Cart. No. Safety and Buildings Division County a 201 W. Washington Ave., P.O. Box 7162 ST. CROIX ►scons►n Madison, WI 53707 - 7 162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 - 3151 6 Sanitary Permit Application St Pl ^ D. Nu tuber T In accord with Comm 83.21, Wis. Adm. Code, personal information you provide 1027185 may be used for secondary purposes Privacy Law, sl5.04(1)(m) Project Address (if different than mailing address) I. Application Information -Please Print All Information"' / / 0 - 2 o ST Property Owner's Name Parcel # Block # SCOTT ALM 018 -1092- 06-000 6 N/A i i':0 4 Property Owner's Mailing Address operty ad rt v. , - 7 1112 MONT CROIX ROAD # /N, E �-A , Sedon City, State Zip Code Pht7ne'Idumberw °�° � 2 J �� HUDSON WI 54016 715/386 -5996 7 `e( (circ a one) II. Type of Building (check all that apply) T 29 N; R . 17 E of WQ Subdivision Name CSM Number 1 or 2 Fa� welling - Number of Bedroom� . �I� ���2�',�'�'^'�' 3 Z 1.(il7 .f/�l� PINE LAKE 45991 ❑ Public /Commercial - Describe Use (S•r (�`� (,P X 7 S 07'L GAY(, � City_ Villa wnship of t°I q,rny1pn ❑ State Owned - Describe Use 9s�� III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑Permit Renewal ❑Permit Revision ❑Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) ❑ Non -Press urized In- Ground ❑ Mound > 24 in. of suitable soil ® Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland [I Pressurized In- Ground 11 Holding Tank 11 Peat Filter Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ] Gravel -less ipe ❑ Other (explain) V. Dispersal/Treatment Area Information: A r Design Flow (gpd) I Desi n Soil Application Rate(gpdsf) Disp rsal Area Re fired (sf) Dispersal Area P oposed (sf) System Elevation 450j 1 + �' 450 Q� 450/ 97.27 VI. Tank Info Capaci m Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank wow WIESER CONCRETE X Aerobic Treatment Unit Dosing Chamber 6, ov ( / WIESER CONCRETE I X VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP /MPRS Number Business Phone Number BENNIE HELGESON 220292 715/772 -3278 Plumber's Address (Street, City, State, Zip Code) W1229 770 AVENUE, SPRING VALLEY, WI 54767 VIII. nt /De artment Use Onl Approved ❑Disapproved Sanitary Permit Fee (i cludes Groundwater Date Issued ssuing Agen Signa re S mps) Surcharge Fee) _ 0 O ❑ Owner Given Reason for Denial �� + f�tn C SY$TEM C�LILAIER �e � Septic tank, effluent filter an� s dispersal cell must all be serviced / m,§intained Pe as per management plan provided by plumber. 2. All setback requirements must be mairitained as per applicable code /ordinances. > SBD -6398 (R. 01/03) A, LA CAJ o h � i � .b CA 1 -� 7 > , •e 4 n `\ O V^ U U LRNMEN7I O7 2 PART OF GOVEL N114 OF THE NEy 4 ALL / IN SECTION 1, MMOND, SST. CROIX COUNTY, WISCONSIP r r i g i r. 1.700 _ t >> rn O.H. ' 1 r C -1 740 r m i Fy UNE aid w M `N T 6 � � 1.478 AC 4ka � ER LINE 2 � AC ter- TO O.N.W.M — —L 11' i 80' a o N 0 N OUSE — 1150 ' CIO 0. H. W. M. ELEVATION 1123.42 448' Wt NOTE: EXISTING DRAINFIELD BE MOVED TO LOT 1 WITH LO 2 EXISTING HOUSE. I 1.7 AC ES M D R ; i 1.84 RE _+ I TO A W M I 4' \ 1 zt Q� \ < Safety and Buildings commerce.wi. OV 4003 N KINNEY COULEE RD g LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 is c o n s i n www.commerce.state.wr.us /sb Department of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary August 09, 2004 CUST ID No.220292 A7TN. POWTS Inspector BENNIE W HELGESON ZONING OFFICE HELGESON EXCAVATING ST CROIX COUNTY SPIA W 1229 770TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/09/2006 Identification Numbers Transaction ID No. 1027185 SITE: Site ID No. 687289 Scott Alm Please refer to both identification numbers, 207TH Street above, in all correspondence with the agency. Town of Hammond St Croix County NE1 /4, NE1 /4, S1, T29N, R17W Lot: 6, Subdivision: Pine Lake Addition FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 972392 Maintenance required; 450 GPD Flow rate; 16 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual, SBD- 10572 -P (R.6/99), Pressure Distribution Component Manual, SBD- 10573 -P (R.6/99); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. Corti No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, AP stats. The following conditions shall be met during construction or installation and prior to occupancy'or'use: Dsp OF 1 General Approval Requirements: SEE COf • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD - 10572 -P (8.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD - 10573 -P (R.6/99). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • feet from an POWTS tank and a minimum of 50 feet from the absorption The well must be a minimum of 25 y area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. BENNIE W HELGESON� Page 2 8/9/2004 • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of See. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the W12roved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats'101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART'code: 7633: (608)789-7893, 7:45 am - 4:30 pm Monday - Friday cbratz @commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 INDEX STREET PROPERTY OWNER: SCOTT ALM �V1 1112 MONT CROIX DR #3 s HUDSON, WI 54016 PROJECT NAME: SCOTT ALM PROJECT LOCATION: NE 1/4, NE 1/4, S 1, T 29 N, R 17 W MUNICIPALITY: TOWN OF HAMMOND COUNTY: ST CROIX DESIGN: PRESSURE DISTRIBUTION MANUAL SBD- 10573- P(R/99) MOUND COMPONENT MANUAL SBD- 10572 -P (R 6/99) CONTENTS: Page 1: Plot Plan Page 2: Cross Section and Plan View of Mound Page 3: Distribution Pipe Layout Page 4: Pump Chamber Cross Section & Specifications Page 5: WLP1000 /600 -MR ZABLE Tank Specifications Page 6: Pump Specifications onally Page 7: POWTS Owner's Manual & Management Plan - Pg. 1 0 V E n Page 8: POWTS Owner's Manual &Management Plan - Pg. 2 OF COMMERCE IL.OIN - SP ONDEN Name: Bennie Helgeson Signe G Address: W1229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 Date: July 28, 2004 Page 41 Synthetic Covering Distribution Pipe ASTM C 3.3 Medium Sand — N G Topsoil � = -- =- F 97.27 E/r ✓. 3 / % b EIkJ. 3 lope V -s'6 S Plowed c: Lt.0 f 2�— 2 %2 Force n Aggregate From Pump Layer D / 6 Ft. E Ft. Cross Section Of A Mound F ,jj?o Ft. G _« S Ft. A Ft. H f Ft. Signed: B 5 - L= -j 'Ft. License Number: L 77S 7t. Date: j Ft. T Jet, Ft. W 9(,. Ft. Observation Pipe — P B _ _ _� — W � T C Distribution E �=L O f 2 2 Pipe Aggregate Observation Pipe Plan View Of Mound C li t", .S CU t 7 A Page j Of � SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS " f ik V ENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF 2 FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W/ PADLOCK E WARNING LABEL 1 4' MIN. Zy" 18 IN INLET " I' WATER TIGHT SEALS GAS- , TIGHT- APPROVED FILTER — A SEAL ; JOINTS WITH APPROVED 2A $E 1 - ,4'�ov � ALM APPROVED PIPE PIPE 3' (aaxl(,'' B ' ON 3' ONTO ONTO SOLID C ' SOLID SOIL SOIL PUMP OFF ELEV . ,SOLTT. —i-- I ' OFF D 3" APPROVED BEDDING -UNDER TANK CONCRETE PAD SPECIFICATIONS _ Yatal �G1s l: SEPTIC / DOSE I TANK MANUFACTURER: ull�x 4-- X TANK SIZES SEPTIC EX)D GAL. DOSE VOLUME INCLUDING DOSE GAL. / �.3 GAL(. FLOWBAC�� GAL. ALARM MANUFACTURER: CAPACITIES: A = '/d• INCHES O 1.6$ GAL. MODEL NUMBER: N LA l SWITCH TYPE: re v- oc;f B = 2 INCHES = PUMP MANUFACTURER : ."l l e e C = _� INCHES = AL. MODEL NUMBER: SWITCH TYPE: `- D = /U INCHES = LL_GAL. REQUIRED DISCHARGE RATE 4 L S M PUMP E ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEE MP OFF AND DISTRIBUTION PIPE / 7 FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . • • • • • • • . ,� FEET + LW _ FEkT FORCEMAIN X �� FT /100 FT. FRICTION FACTOR FEET TOTAL DYNAMIC HEAD = ET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH ER �.I Q U I D D s SIGNED: LICENSE NUMBER: DATE: 1/88 A LM At DYNAMIC HcAD/CAPACITY HEAD CAPACITY CURVE "t_R I`1lllufE ri rdl V10 tWWAIERING MODEL 1521153 UJ t MOOLL ( 15 "C 153 tz -- 50 Feet Meters Gal. Liters Gal. Liters 153 5 1.5 69 261 77 291. U 3.1 61 231 70 265 12- 40 152 15 4.6 53 201 61 231 20 6.1 44 167 52 197 v 30 25 7.6 34 129 42 159 8 30 9.1 23 87 33 125 20 SD 10.7 -- -- 22., 85 o 40 12.2 4 �- Kic Lock Valve: 38.0 Ft. (11.6m) 44.0 Ft. (13.4m) 10- 014 soe 0 20 40 60 80 100 GALLONS _ s 1/4 0 — LITERS 80 160 240 320 3 27/32 -- f-- - -- - 5 /8- FLOW PER MINUTE j % 3 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS �<<�_ _ • Timed dosing panels available. U e 3 27/32 • Electrical alternators, for duplex systems, are available and supplied with 0 an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. I • Sealed Qwik -Box available for outdoor installations. See FM1420. • Over 130 °F. (54 °C.) special quotation required. 1521153 Series 12 1/8 1 153 MODELS Control Selection Model Vofts•Ph Mode Amps Sim lex Duplex - 5 1/8 N1152 115 1 Non 8.5 1 2 or 3 BN152 115 1 Auto 8.5 Included 2 or 3 1 -,— sK2064 E152 230 1 Non 4.3 1 2 or 3 SE152 230 1 Auto 4.3 Included 2 or3 N153 1 115 1 1 Non 10.5 1 2 or 3 aN1531 115 1 I Auto 10.5 Included 2or3 SELECTION GUIDE E153 1 230 t Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float SE1531 230 1 1 Auto 5.3 Included 2 or 3 switch. Refer to FM0477. O CAUTION 2. See FM0712 for correct model of Electrical Alternator E - Pak. All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10 - 0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed including the most system. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). or () float s y RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Z oeller pump. MAIL TO: P.O. BOX 16347 Z r Louisville, KY 40256.0347 Manufaclurers of.. SHIP TO: 3649 Cane Run Road • ,�}`�e �� ® Louisville, KY 40211 -1961 Quuirr/P11a,Ps Ski- /9NY 2 • 00 928 -PUMP http ✓Avww.zooll er. corn 4 a M !O, ( ) 778.2731.1 8 FAX (502) 774 -3624 © Copyright 2001 Zoeller Co. All rights reserved. Wisconsin Department of Commerco SOIL EVALUATION REPORT Page / Of Division of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code Count Attach complete site plan on paper not less than 81/2 x 11 Inches In size. Plan must O/ �_ �� 2 � percent slope. 80810 of dimensions^ o�arrow' po int and location and distance e o near nearest road. R a I.D. R ew Data Please print all Information. Personal Information you provide may be used for secondary purposes (Privacy Lew, s. (1) (m)). Pro rty (,ovation property Owner ±S" 1/4 S T o 1 rf N R 1 E( W S (f ` �' .4 � � Govt Lot 7 ' Lot # Block # Property Owners Mali) Address / 9L 7X-5 6 y� - 7 �o ©o rP �� rest Road city State p Code Phone Number ❑City ❑Village own Nea Ux,4 �3 �� S sI� S (A51 )a / y -3S ct M m o•� New Conswctim Use: Residential /Number of bedrooms Code derived design flow rate `% > GPD ❑ Replacement (3 R Public or commercial - Describe: Parent material cr Flood Plain elevation if applicable O" C f General comments 7 i �' e �� �<��> c3 // and recommendations: C.f� E Ccs Al 7' � 4 S. mele - EL C). V-% S El '/ Q Boring Boring # (']''�� Ground face elev. ft. Depth to limiting factor -JL In. UOf1 Rate Structure L''l Plt surface �� Horizon Depth Dominant Color Redox Description . Texture Gr. Sz. Sh. Consistence Boundary In. . in. Mu Qu. Sz Cont. Color ff t1 `�- �� , 3 ,•Sy Boring # 0 dorin9 ?�/ Q c� pit Ground surface elev. - 1— c -.�- -- h' Depth o limiting factor __�Z.___ � A RM$ son catlon t Color Redox Description Texture Structure Consistence Boundary Horizon Depth Domf nan Gr. Sz Sh. in. Munself Qu. Sz ConL Color .� s SC L 6 cy 3 c a > < and 'SS >30 <_ 150 mg/L ' Effluent #2 = BOD _< 30 mglL and TSS _< 30 melt. Effluent #1 BOD 30 _ 220 nI CST Number CST Name (Please Print) Signature Data Evaluation Conducted Telephone Nurnow Address L / t,J/ 9 770 f' t. 40 Page of Pa rcel ID # Property Owner � - - Jz -! 22 ❑ Boring Depth to limiting factor —L L -- th Soil Ikation Rate Boring # Ground surface elev. _� � h GPDlf!` ' Pit Structure Consistence Boundary Roots Redox Description Texture •Etf#1 *002 Horizon Depth Dominant Color Gr. Sz. Sh. E in. Munsell Q Cd u. Sz Cont. or t) I - lu 7S [� Boring Depth to limiting factor — in. Soil don Rate Boring # ❑ pit Ground surface elev, n• �� GPDI(f El Redox Description Texture Structure Consistence Boundary •Eff#1 Horizon Depth Dominant Color Gr. Sz. Sh. in. Munsell Qu. Sz. Cont. Color ❑ Boring Depth to limiting factor �• Sol lcai Rate Boring # Pit Ground surface elev. -- ft• PD Structure Consistence Bou�ary Roots Redox Description Texture •�±I 'Etf#Z Horizon D Dominant Color Gr. Sz. Sh. in. Munsell Du. Sz. Cont. Color I Effluent #1 = SOD mg/l. and TSS > 30 : 5 150 mglL ' Effluent #2 = BOD 30 Mgr• and 7SS c 30 � E s > 30 5 220 Commerce is an equal opportunity service provider and employer. if YO � assist 688 t>¢8��� Serv or Comm 60 8 - 266 - 3151 merit of ent at The Department lease contact the departm need material in an alternate format, p SIID•t)) (II.AlUO) � y I LI f ID e j Lij id r v O � 1 o m J-4 OD IN •d d w -ts ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer `.Jea A Lul Mailing Address 1 N 6 n+ Grc� t x �oc 4- S Property Address zz 9 °07 .5 7` — (Verification required from Planning Department for new construction)_ City /State •'k iMa 1l1) fh) t i Parcel Identification Number LEGAL DESCRIPTION . 7 3� Property Location N L /4, N 1: /s, Sec. 1 , T a�N -RAW, Town of rya m m nd Subdivision Lot # 69_ 1 Certified Survey Map # S r1 1 / , Volume X Page # o? — • Warranty Deed # 74 1 Volume Page # Spec house O yes 0 no Lot lines identifiable ® yes 0 no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Propermaintenaaae consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal SyStM is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of Sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. CerdfiCati= stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office'withiu 30 days of the three year expiration date. 62 ' Z&A all" 05PATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the ownet(s) of the pr perty described above, by virtue of a warranty deed recorded in Register of Deeds Office. h� NATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from (lie Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page � of FILE INFORMATION SYSTEM SPECIFICATIONS Owner SCOTT ALAI Septic Tank Capacity 1000 al ❑ NA Permit # 3 Septic Tank Manufacturer WIESER CONCRETE ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ZABEL ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model A -100 12" x 20" ❑ NA Number of Public Facility Units NA Pump Tank Capacity 60 a l ❑ NA Estimated flow (average) �7 al /da Pump Tank Manufacturer WIESER CONCRETE C3 NA Design flow (peak), (Estimated x 1.5) al /day Pump Manufacturer ZOELLER PUMP CO ❑ NA Soil Application Rate 1 . S gal/day/ft' Pump Model 153 ❑ NA Standard Influent /Effluent Quality Monthly average" Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ® NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (gravity) ❑ In -Gr ressurized) Total Suspended Solids (TSS) 530 mg /L U NA ❑ At -Grade Q Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line they: Y Other: ❑ NA Maximum Effluent Particle Size Other. Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency ❑ month(s) (Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: 2 year(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA ❑ month(s) (Maximum 3 years) [3 NA Inspect dispersal cell(s) At least once every: 2 I$ year(s) IR month(s) ❑ NA Clean effluent filter At least once every: 13 year(s) month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: 13 year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: 3 Q year(s) ❑ month(s) ❑ NA Other: At least once every: ❑ Y ear(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) OWNER: SCOTT AU1 Page 8 of,� System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power Is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result In the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes, cigarette butts; condoms; cotton swabs; degreasers; dental floss ;'diapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONOMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with ch. Comm 83:33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the vold space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: O A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction.and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. A suitable replacement area is not available due to setback and/or soil limitations. Barring advances In POWTS echnology a holding tank may be installed as a last resort to replace the failed POWTS. Ak T , At5ite has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and tt a ua ' n m st be pe locate a s ' t area. If no ent area Is available a olding nk may be ' lied as a last resort to replac=he ailed POWTS. ound and at -grade soil absorption systems may be reconstructed in place following removal of the blomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER r Name HELGESON EXCAVATION INC Name JOIIN, r SANTIATION Phone 715/772 -3278 *Phone / 2 73 _ 981 1 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name JOHNSON SANITATIOPi Agency ST. CROIX COUNTY ZONING Phone 715/273 -5811 Phone 715/386-4680 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and sanitation agencies. This document meets the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code Use of this document does not guarantee the performance of the POWTS. GMW (2/01) Page 1 of 1 From: Steven Fisher Sent: Tuesday, February 04, 2003 2:42 PM To: @Zoning Department Subject: Hold Permits on Pine Lake Subdivision Please withhold the issuance of septic permits related to Pine Lake subdivision until the followin) items are resolved: • A Chapter 30 permit is issued from the DNR. • The dedicated public roadway is constructed. I will be requesting that the Town of Hammond withhold any building permits until these items a completed as well. Jane /Shay would you please flag appropriate files. a� Sic � 2/4/2003 qa 9W Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and BcatidlreDs 16 accordance with Comm 85, Wrs.. Adm. Code C Attach complete alto plan on paper not less than 8 1/2 x 11 inches in size. Plan must Ounty S t r,E K Include, but not limited to: vertical and horizontal refer . rection and Parcel I.D. percent slope, scale or dimensions, north arrow, 0 n di t9 n nearest road. Please print all BtfOn Reviewed by Date Personal Inrom»Uon you provide may be used t ary pun Law, (5, (t) (m)). perryowner P Location S L r�DF1� L N c � ' y kr! GoR: ,3 SW imA r ' 114 S 1 Tj N R f , ;r(or) W Property Owners,Mailing Address 37 X Lot$' Block # Subd. Name or CS 10 cot�rY ` 1 O t CSm vws aa3 CRY State ode [:]'Village - 51 Nearest Road' �3 W ra Aim r4 P W ® New Constriction Ilse: 59 Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material �`- G 1- * 1 Z' �- Flood Plain elevation If applicable is comme so rTi� a� y roe m ov Np SY S rrm , ! ► I Boring # ® Boring f? Pit Ground surface elev. q ft. Depth to limiting factor ^ _ In. SoU ApplIcallon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rood GPOM In. Munsell Qu. Sz. Cons Color Gr. Sze Sh. 0 0#1 'Ef#2 7 , 5 X- S/2� 5) 091 & S F .� & 5 1 ^ L ph 3 43,t. b5 g G 3 3 -S o S C)- m-1 s M rF ' NP lYG Boring # ❑ Boring ® Pit Ground surface sieve 1H 1— ft. Depth to limiting factor 2 2 in. Sod A Rai Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM M. Munad Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0#1 '002 l D- .9 Vat 3 /it Sly. mso-e r) S/-/ A s 3 G2.- ;M364- n Gov G - 3 x(-30 7".5, 1 Y& '3 w (1 CL- - )m 3 13e rn F,' cilv -- VP NP IVF ty ' EMuent #1 - SOD > 30 = 220 mglL and TSS >30 g 150 mgfL ' Effluent #2 = BOO 130 mg& and TSS 1 30 mWL CST Neme (Reese Print) Sl nature �� Number Data Evaluation Conducted Telephone Number Address �a a ST, W, Y)l728 Property Owner sF &l- Ua�� b-A4 0 CO, Parcel ID # Page _ of Bodng # t Boring t� ❑ Uey Pit Ground surface elev. % 12 R. Depth to limiting factor � � In. Soli llcaUon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMf In. Munsel Qu. Sz. Cont. Color Gr, Sz. Sh. 'Eff#1 •Ef1#2 C v-- 7t V e s/� -- s 1 L .1 MAS k SOS F 3 �'r, �> N� ❑ Boring # ❑ eo�g . ,. Pit Ground surface slev. R. Depth to limiting factor in. Sol AgWcabon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMtr in. Munsel Qu, Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ❑ Boring # ° Boring pit Ground surface else. R. Depth to in,ltir,g factor M. Sol AppOcallon Rate Horizon Depth Dominant Cow Redox Description . Texture Structure Consistence Boundary Roots GP DOF In. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Ef#2 ' Efitw t #1 = BOD > 301 220 mWL and TSS 40 1150 mg/L ' Effluent #2 = BOD, 130 not and TSS : 130 mg1L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608 -264 -8777. SOD-1330(LW) O'l1✓vvI �. aT N Yv00b S N `A j4 RA;'f Poe ) - Ie- I S Csr� • ST. CROIX COUNTY WISCONSIN «. „ «« ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 « Fax (715) 386 -4686 June 12, 2002 Mike Sliva Secluded Land Company, Inc P. O. Box 99 Barron, WI 54812 Re: Pine Lake Subdivision Dear Mr. Sliva: The Zoning Office has been informed that road construction and house construction have taken place on the above subdivision prior to the installation of erosion control measures on the site. This is in violation of the Erosion Control Plan approved by the Land and Water Conservation Committee on September 4, 2001, which states that storm water ponds and overflow drainage ditches are to be constructed first along with appropriate erosion control measures, prior to any roadway construction. St. Croix County Subdivision Ordinance provides that financial guarantees be submitted to ensure the proper construction, installation and maintenance of required roads, utilities, erosion control measures, and other improvements. The County has the authority to utilize these guarantees to see that improvements are properly constructed and completed. It is imperative that you, as the developer, take immediate action to correct the violation noted. By Friday, June 21, 2002, you are to have installed the appropriate erosion control practices, and have them inspected by the Land and Water Conservation Department. On June 11, 2002, yourself and Peter Kling of the Land and Water Conservation Department, agreed upon the following actions: 1. Install two rows of silt fence in the ditch upstream and two rows of silt fence ve along 117 Straw bales will also be in the ditch downstream of the culvert g added as extra protection. 2. Install silt fence around the east side of the dirt pile along, east of the temporary driveway. 3. Install silt fence between the west side of the temporary drive and the south side of the abandoned driveway. This will catch runoff from the west side of the temporary driveway. Page 2 June 12, 2002 Secluded Land/ Pine Lake Subdivision 4. Install two rows of silt fence in the south ditch of the existing driveway, just east of the intersection with the temporary driveway. Straw bales will be added for extra protection. This will catch runoff from the east side of the temporary driveway. You and your engineer must work cooperatively with the Department of Natural Resources during the Chapter 30 permit process to ensure compliance with their requirements. If these items are not completed by June 21, 2002, citations may be issued in accordance with St. Croix County Subdivision Ordinance 18.23 Violations and Penalties. Additionally, financial guarantees may be utilized to obtain compliance. Until compliance with the approved erosion control plan has been obtained, and the appropriate DNR permits issued, sanitary permits will not be issued for additional residences proposed within the subdivision. Should you have questions or concerns, please feel free to contact this office. 4t 4 Mary J Jenkins Assistant Zoning Administrator C: Peter Kling, St. Croix County Land & Water Conservation Department Ken Peterson, Chairman, Town of Hammond Eunice Post, Department of Natural Resources Steve Wlodyga, Pine Lake Association File U 2421P 571 '741693 1? STATE BAR OF WISCONSIN FORM 2 - 1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI Document Number RECEIVED FOR RECORD Ii This Deed, made between Secluded Land Company, LLC, a 09/29/2003 10:00AN Wisconsin limited liability com a n_� WARRANTY DEED _ - -- -- -,- -- EXEMPT i !l _ Grantor, REC FEE: 13.00 i and Scott D. Alm, A Single Person SMN Residen TRANS FEE: 449.70 (I i COPY FEE: CC FEE: -- -- - — PAGES: 2 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following i• described real estate in St. Croix County, State of Wisconsin: Rocording Atoa . Name and Return Address Bee attached Addendum A for legal description and ; protective covenants. Secluded Land Company, LLC P.O. Box Desoto, WI 54624 I !� I Part of: 018• - 1000 - 80 - 175 'I i , Parcel Identification Number (PIN) �I This is not homestead property. is not {I �i This is non — marital property for James W. Smith. �i %.I I Grantor hereby transfers all interests in minerals, if any, it may have in the subject 1 i property. t Municipal and zoning ordinances, any recorded easements, recorded Exceptions to warranties: building andi!use restrictions and covenants, general taxes levied in the year of closing, and any liens or encumbrances created by the Grantee. I , j Dated this 15th day of September 2003 !' Seclud and Comp An LLC b i I (SEAL) 9 (SEAL) I! * James W. Smith, Sole Managing Me mber I1 I ' (SEAL) —_— (SEAL) l: AUTHENTICATION ACKNOWLEDGMENT Signature(s) James W. Smith State of Wisconsin, i ss. 9C�_/� County. authenticated t day of 2003 Personally came before me this day of the above named John P. Ebben, Attorney TITLE: MEMBER STATE BAR OF WISCONSIN - -_ - - -- to (If not, me known to be the person who executed the foregoing authorized by §706.06, Wis. Stars.) Instrument and acknowledge the same. is THIS INSTRUMENT WAS DRAFTED BY - - - -- - - -- Attorney John P. Ebben Notary Public, State of Wisconsin My commission is permanent. (If riot, state expiration date: (Signatures may be authenticated or acknowledged. Both are not _ ) necessary.) SDB- .313 I. ' Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. lnc. WARRANTY DEED (B) PT_, #6 L. S. FORM No. 2 - 1998 Milwaukee. Wis. U 2421P 572 ADDTNDI:IrI A LEGAL DESCRIPTION GRANTOR: SECLUDED LAND COMPANY, LLC PINE LAKE GRANTEE: SCOTT D. ALM Lot 6 Lot 6 of the plat of Pine Lake recorded at the Office of the St. Croix County Register of Deeds on March 19, 2002 in Volume 8 of Plats, on Page 98 as Document No. 673841, located in Part of Government Lot 2, Part of Government Lot 3 and part of the Southwest Quarter (SW %) of the Northeast Quarter (NE' /4 ), All in Section 1, T29N, R17E, Town of Hammond, St. Croix County, Wisconsin. PROTECTIVE COVENANTS 1. The Grantees agree that no singlewide or doublewide mobile homes, campers or buses shall be placed upon the premises herein conveyed. "Mobile Homes" includes any and all trailers or structures previously licensed or titled for road use; and trailers or structures with wheels and/or axles attached at any time, whether placed on a foundation or not. 2. The Grantees shall not permit unregistered or abandoned vehicles, trash, or junk to remain on said premises. 3. No accessory buildings such as garages, pole buildings or sheds may be constructed or placed upon the premises until a primary residence with completed exterior is fully constructed. All structures shall have exterior finish, clapboard siding, masonry, or equal quality finish. No tar paper, tar shingles, or tar paper siding. 4. All structures erected shall be promptly and expeditiously completed on their exterior, including paint or stain, on any exterior surface above the foundation within six months after construction is commenced. 5. The main residential structure(s) must have a minimum of 1,500 square feet of living space, 6. Should any improvements on the premises be damaged by casualty, or become unsightly through wear and tear, the same will be promptly razed, or restored to a neat exterior appearance in line with the building requirements above set forth. 7. There shall be no hunting or discharge of firearms on the premises. 8. The land is restricted against commercial timbering and commercialization. 9. The Grantees are prohibited from placing advertising signs of any nature upon the premises. 10. Owners of Lots 2, 3, 5 and 6 of the Plat of Pine Lake shall be encouraged to join the existing Pine Lake Association, Inc. and utilize "Best Management Practices" as outlined by the Wisconsin Department of Natural Resources and practiced by the lake association members. 11. The use of fertilizers, insecticides and herbicides is prohibited on the portions of all lots that slope toward Pine Lake, and only non - phosphorous fertilizers can be used on the remaining portions of lots. 12. Lots 2, 3, 5 and 6 of the Plat of Pine Lake shall maintain a buffer strip 20' from the ordinary high water mark of Pine Lake within which only the following cutting is permitted: a. one 30' wide tree cutting view corridor per lot may be cut through the 20' buffer strip; b. only trees smaller than 4" in diameter (at a height of 4' above the ground) may be out within the view corridor, provided existing ground cover and any root structure are not disturbed. c. trees may be removed in the buffer strip, if dead or diseased, provided existing ground cover and any root structure are not disturbed. View corridors on adjacent lots may not be contiguous. County Shoreland Zoning or other laws/regulations may restrict further cutting. 13. Declarant was required by St. Croix County to have an approved comprehensive water drainage and soil erosion plan for the subdivision. No owner or resident shall do anything, which would interfere with or change the operation of this plan. This includes, but not limited to, building upon, obstruction, altering, filling or excavating or planting in, any pond easements, water drainage ditches, water runways, water culverts, berms of grass seedings. Information about the approved comprehensive water drainage and soil erosion prevention plan may be obtained from St. Croix County. 14. These eighteen protective covenants may be superseded by previously recorded restrictive covenants, or by local and county zoning regulations. 15. These eighteen protective covenants may be amended, subject to the following: a) Such amendment shall be in writing; b) The amendment must be approved in writing by the owners of a two -thirds majority of the parcels in the subdivision; c) The amendment shall be recorded. 16. These eighteen protective covenants shall run with the land and shall be binding on the Grantee(s), their heirs, successors and /or assigns. 17. The Grantees understand that they, along with St. Croix County, have standing to sue for enforcement of the foregoing protective covenants. Enforcement is primarily Grantees responsibility after half of the parcels offered for sale by Grantor in this project have been sold. 18. In the event any portion of the foregoing protective covenants is judicially deemed invalid then the remaining portion of said protective covenants shall remain in full force and effect. (B)PL#6 1.475 Acres PCAD Pine Lake (12130102) v k ol� 1. b of a Z " O W 7 O All /l 5 W/ / 3 Q \ Z, J \ 0 ��� / 0 r Z 000, ojp� r OtA \� i LLl N LU w a: ° LJ I ^Z mw w, ° ��a� WIL 0 5 F- a�EQO o � p� i w O n N� +11 w °m om a n Z o fl W c `! i I J 't m k'T �i X86 Q �. I _w cc T aTw W3: u N d��� ,� J Tro E"< �• w I CC 7 = F c0 IQ�o QO I W Z +1 LLI ♦ :N T T w C - \\\` w 1 ♦\ x \\ I aZ /\ ' 4 / � r U \�A 424.3Z- 2L ro IL tL 00 526.4V T �V \ V \ �y ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER —' 1101 Carmichael Road Hudson, WI 54016 -7710 EROSION & SEDIMENT CONTROL PLAN (715) 386 -4680 • Fax (715) 386 -4686 Site: 1187 207th St., Lot 6 (Hammond Twp.) — Owner(s) Scott Alm Parcel # 01.29.17.738 Under St. Croix County Zoning Code 17.70(3)(b) 5: "The (Zoning) Administrator may attach reasonable erosion prevention conditions to a permit approved for issuance." Wisconsin Admin. Code Comm. 21.125 requires the building permit applicant and /or landowner to follow erosion control procedures and maintain them until the site has been stabilized. Erosion control is a requirement of the conservation easement recorded for this lot. The Owner is responsible for notifying all contractors performing construction on this site that an Erosion & Sediment Control Plan is in effect and the following activities will be required in order to maintain compliance with the plan: I . The primary source for construction site runoff will be the house foundation excavation, driveway, and any soil stockpiled until final grading and stabilization is complete. Septic system installation adds to temporary disturbance, but establishing cover on exposed soils will prevent erosion. Apply seed and mulch as recommended in #5 below. Maintain existing vegetation wherever possible to minimize sediment movement. Surface drainage flows northeasterly toward a storm water pond and to Pine Lake. The proposed septic system is 100 ft. from the retention pond and >300 ft. from the shoreline of Pine Lake. 2. Intercept and route contaminated runoff into stabilized vegetated buffer areas by creating temporary diversions graded ALONG CONTOUR between construction areas and any potential receiving waters (includes drainage ditches). Do not allow diverted runoff to be directed into the retention basin or overflow channel inunediately adjacent to the proposed house and driveway construction areas. (See specification sheet for temporary diversions provided by Zoning Dept.) 3. If excavator grades the site to create temporary diversions (see #2) to contain sediment and leaves adequate vegetative cover to protect areas of concern, installation of other products may not be necessary. However, silt fence, straw wattles, or other approved sediment control products will be required if sediment cannot be contained on owner's property with diversions and vegetative buffers. The POWTS or Building inspector may evaluate ESC plan effectiveness and make recommendations to owner for any action required to comply with applicable regulations. 4. Construction equipment and vehicles must utilize a stabilized driveway access off public road for heavy equipment; this includes cement trucks, well drillers, and other contractor's vehicles that access the property during construction. This helps avoid muddy, rutted conditions that may allow contaminated runoff to reach waterways and/or drainage ditches. Property owner must repair damage to ditches resulting from multiple access points and sediment tracked on public roadways must be removed at the end of each workday. 5. Stabilize new topsoil cover over septic system with seed and mulch immediately after installation - do not wait for final stabilization and/or landscaping of entire site to cover exposed soils on the system. If weather will not permit seed germination, a heavy straw mulch cover will prevent erosion until grass /vegetation can get established. Erosion control matting can be applied any time of year and if installed properly, will provide protection even if seed germination is delayed. The owner of record during site construction will be responsible for compliance with the ESC Plan. Please feel free to contact me with questions regarding erosion & sediment co alla ' Prepared by: Pam Quinn, Soil Erosion Inspector #66505 Owner acknowledgement of ESC Plan requirements: a312004 nd ' Wisconsin Department of Commerce SOIL EVALUATION REPORT ��Q/r` Page of Division of Safety and Buildings -� in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 Inches In size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. �� Z' 6' 1 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Da e Please all information. R ew Personal Inf ormation you provide m be ujed rwsQCYrdiypyrposss gd v iloy Law, s. 15.04 (1) (m)). Property Owner Property Location y� 14 l Govt. Lot It 1/44 1/4 S/ T 'I q N R 17 E( W SCo Owner's Malli Address Lot # Block # Subd. ame or C� / M# ` / J�, s!a�Ce Jub�r�J(Srb Property Owner's �t City State zip C r e Phone " mbar ❑ City ❑ Village own Nearest Road 1 rv. rn 6n d Sf rc - New Construction Use: Residential / Number of bedrooms _ Code derived design flow rate yid t3PD ❑ Replacement C3 Public or commercial - Describe: R Parent material S �' cr I Flood Plain elevation if applicable General comments - i C e w / /� a 0 o f 6, �. 6 6 A Gr'-e� and recommendations: ��� (,X '7 0 r [1 Boring Boring # ft, Depth to limiting factor _ Lam— In. tion Rate M—Pit Ground surface elev. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *011#11 •Ef In. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. 3/ a I c� ` /�2 s ' s � . S c3 Sc L UL - ,s Y 5 Boring ► � Boring # Pit Ground surface elev. ft. Depth to limiting factor In. S (cation Rate LJ Roots GPD/(! Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary 'Eff#1 �$ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. a li a J - -� -3 s � sc L , a 3 �- ( - b Effluent #1 = BOD > 30 _< 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD _< 30 mg/L and TSS _< 30 WO/L re CST Nurnber t Signature CST Name (Please Print) S PS a Date Evaluation Conducted Telephone Number Address iIJ JL)f 3 (7 Gvl 9 770 t � _ Property Owner 5 c ° 1�L "�` Parcel ID # Page � of El b - Boring # Boring & g h. Depth to limiting factor ._ in. Soil ApplicaiW Rate Pit Ground surface elev. _ Texture Stricture Consistence Boundary Roots GPDM Horizon Depth Dominant Color Redox Description Gr. Sz. Sh. 'Eff #1 - *002 in. Munsell Qu. Sz. Cont. Color I U s r J D1 b-6, 0`1 '� o o S , SL csbk +/ -r l sb 7S [] in. a Boring Boring # h, Depth to limiting factor SoU cation Rate ❑ Pit Ground surface elev. Texture Structure Consistence Boundary Roots GPDAI Horizon Depth Dominant Color Redox Description Gr. Sz. Sh. 'Eff#1 in. Munsell Qu. Sz. Cont. Color Boring Depth to limiting factor in. E] Boring # Ground surface elev. n• Sol ication Rate ❑ Pit P Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'Eff#1 'Eff#2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 30 < 220 mglL Effluent #1 800, > and TSS >30 150 mglL ' Effluent #2 = BOD, S 30 mglL and TSS < 30 mglL ' = _ The Department of Commerce is an equal opportunity service pro ide andr at 608 -266 nee TTY anc to ACCOU services of need material in an alternate format, please co P en SUD•3330 (KAM) _5 l l ` \ t \ 1 N� s a . f w o i t i -s Vj Ll pi O � 1 i v � { CZ) �,� LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF HAMMOND COMPUTER NUMBER 018 - 1092 -06 -000 Parcel Number 1.29.17.738 OWNER NAME: First SCOTT D Last ALM PROPERTY ADDRE S: Hse # 112 PD -- Street Name -- Type SD Apartment v SECTION 1 TOWN 29N RAN 'E 11 4 11440 Line Description Line Description TOTAL ACREAGE 1.475 PLAT PINE LAKE SUB LOTS 2/6 018/02 LOT06 BLK 01 SEC 1 T29N R17W PT PT NE 1/4 15 02 PT GOV LOT 3 & PT GOV LOT 4 16 03 PINE LAKE SUBDIVISIO 04 1. 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 i F1- General 174 -Prev. Parcel F5 -Next Parcel, F7- Valuations F8-History, F10 -Exit ry,